This invention relates to a device utilizable with an endoscope for performing surgical operations with the aid of the endoscope. This invention also relates to an associated surgical method. The device and the method are particularly efficacious in the treatment of achalasia. In a modified form, the invention is applicable to the treatment of bleeding varices, particularly gastric and/or esophageal varices.
Achalasia is a chronic motor disorder resulting from aperistalsis of the smooth muscle portion of the esophagus and leading to functional obstruction proximal to the lower esophageal sphincter. The pathogenesis involves degeneration of the nerve cells of Auerbach's plexis, which in turn leads to aperistalsis and incomplete relaxation of the lower esophageal sphincter. The clinical manifestations include dysphagia, i.e., difficulty in swallowing, for both liquids and solids.
One of the most effective treatments of achalasia is forceful pneumatic dilitation or dilation of the esophagus. This procedure entails the passage of a balloon into the esophagus under fluoroscopic guidance. Once the balloon is positioned at the gastroesophageal junction, the balloon is suddenly and forcefully inflated, thereby tearing muscle fibers. When done correctly, this procedure provides the patient with relief of the symptoms and results in improved swallowing.
The forceful pneumatic dilitation or dilation of the esophagus frequently results in complications due mainly to an incorrect placement of the balloon. Because the balloon is positioned under fluoroscopic guidance, visualization is sometimes inaccurate and the balloon is inflated at an improper location. Such error can cause perforations of the esophagus.
Another gastroesophageal disorder is bleeding varices. Gastric and esophageal varices are a devastating complication of portal hypertension. To treat such bleeding varices, it is necessary at times to use a long tube with two inflatable balloons at a distal end, known as a "Blakemore Tube." In using this device to stop the flow of blood in the stomach, the tube is blindly inserted into the esophagus until it is believed that the most distal of the two balloons is located in the patient's stomach. That balloon is then inflated and the tube placed in tension (e.g., via attachment to a weight outside of the patient) to pull the inflated balloon against the stomach wall at the gastroesophageal junction. In the event that bleeding esophageal varices are to be treated, the relatively proximal balloon is also inflated.
The rate of complications in the use of the Blakemore tube is immense. The complications result mainly from poor placement or slippage of the tube. In addition, the relatively proximal balloon sometimes erodes into the esophagus, causing bleeding, perforation and necrosis of the esophagus.